Lip Tie in Babies: Symptoms, Diagnosis, and Treatment
Key points
- Difficulty Latching: The baby may struggle to create a deep latch, causing the upper lip to be tucked in rather than flanged out.
- Poor Seal: An inadequate seal can cause clicking or smacking sounds during feeding and may result in milk leaking from the corners of the mouth.
- Poor Weight Gain: Inefficient milk transfer can lead to slow or inadequate weight gain.
- Prolonged or Frequent Feedings: The baby may feed for very long periods or seem constantly hungry due to not getting enough milk at each session.
- Fussiness and Gas: Swallowing excess air from a poor seal can lead to gassiness, colic-like symptoms, and frequent spitting up.
A lip tie is a condition present at birth where the band of tissue connecting the upper lip to the gum, known as the labial frenulum, is unusually thick, short, or tight, restricting the upper lip's movement. While every person has this frenulum, it is considered a "tie" when its structure interferes with normal functions like feeding.
The primary concern with a lip tie in infants is its potential to cause breastfeeding difficulties. The condition is often discussed alongside tongue tie (ankyloglossia), a similar condition involving the tissue under the tongue.
Signs and Symptoms of a Lip Tie
Symptoms of a lip tie are most apparent during feeding and can affect both the baby and the nursing mother.
Symptoms in Infants
- Difficulty Latching: The baby may struggle to create a deep latch, causing the upper lip to be tucked in rather than flanged out.
- Poor Seal: An inadequate seal can cause clicking or smacking sounds during feeding and may result in milk leaking from the corners of the mouth.
- Poor Weight Gain: Inefficient milk transfer can lead to slow or inadequate weight gain.
- Prolonged or Frequent Feedings: The baby may feed for very long periods or seem constantly hungry due to not getting enough milk at each session.
- Fussiness and Gas: Swallowing excess air from a poor seal can lead to gassiness, colic-like symptoms, and frequent spitting up.
Symptoms in Breastfeeding Mothers
- Nipple Pain or Damage: A shallow latch can cause sore, cracked, or bleeding nipples.
- Pinched or Lipstick-Shaped Nipples: After a feeding, the nipple may appear flattened or shaped like a new tube of lipstick.
- Reduced Milk Supply: Inefficient milk removal can signal the body to produce less milk over time.
- Blocked Ducts or Mastitis: Incomplete draining of the breast can lead to these painful conditions.
Signs in Older Children
- Gap Between Front Teeth (Diastema): A thick frenulum that attaches low on the gum line can prevent the two upper front teeth from coming together.
- Difficulty with Oral Hygiene: A tight lip may make it difficult to brush the upper front teeth, potentially increasing the risk of cavities.
- Gum Recession: In rare, severe cases, the constant pulling from the tight frenulum can contribute to gum recession over time.
Watch a video explaining lip ties in babies
Lip Tie vs. Tongue Tie
Lip ties and tongue ties are both types of tethered oral tissues (TOTs) but affect different parts of the mouth.
| Feature | Lip Tie | Tongue Tie (Ankyloglossia) |
|---|---|---|
| Location | Involves the labial frenulum, connecting the upper lip to the upper gum. | Involves the lingual frenulum, connecting the underside of the tongue to the floor of the mouth. |
| Primary Function Affected | Restricts the upper lip's ability to flange outward, affecting the seal during feeding. | Restricts the tongue's range of motion, impacting sucking, swallowing, and later, speech. |
| Co-occurrence | It is common for infants to have both a lip tie and a tongue tie. |
"When a baby has a significant lip tie, it can be challenging for them to maintain a good latch and get enough milk. Once the tie is released, mothers often report a noticeable improvement in breastfeeding." - Lactation Consultant
Diagnosing a Lip Tie
A lip tie is diagnosed through a physical examination by a healthcare professional, such as a pediatrician, pediatric dentist, ENT specialist, or a lactation consultant. The provider will gently lift the baby’s upper lip to visually inspect the frenulum and assess its thickness, elasticity, and attachment point.
Diagnosis is based not just on the appearance of the frenulum but on its functional impact. A tie is only considered problematic if it is causing symptoms.
Classification of Lip Ties
A common system classifies lip ties based on the frenulum's attachment point:
- Class I: The frenulum attaches high up on the gum, away from the teeth ridge.
- Class II: The attachment is on the gum line.
- Class III: The frenulum attaches lower on the gum ridge, where teeth will erupt.
- Class IV: The frenulum is thick and extends down to or through the future location of the front teeth.
Treatment Options
Treatment for a lip tie is only recommended when it is causing significant functional issues.
1. Conservative Management
If a lip tie is mild and not causing problems, a "watch-and-wait" approach is often best. A lactation consultant can provide strategies to improve latch and positioning, which can sometimes compensate for a minor tie. Many frenulums also become less restrictive as a child grows.
2. Frenectomy (or Frenulotomy)
When a lip tie causes significant feeding problems, a simple surgical procedure called a frenectomy can release the tight tissue.
- Procedure: A frenectomy is a quick procedure performed by a trained pediatric dentist, ENT, or physician. It can be done using sterile surgical scissors or a soft-tissue laser. A topical or local anesthetic is typically used to numb the area. The procedure itself takes only a few seconds.
- Aftercare: After the procedure, parents are instructed to perform specific stretching exercises for several weeks. These stretches are crucial to prevent the frenulum from reattaching as it heals. The wound typically heals within one to two weeks, appearing as a white or yellowish diamond-shaped patch before returning to a normal pink color.
- Risks: A frenectomy is a low-risk procedure. Potential complications are rare but can include minimal bleeding, infection, or reattachment of the frenulum if aftercare instructions are not followed.
See an example of an infant lip tie release procedure
Outlook and Recovery
For infants who undergo a frenectomy for feeding issues, many parents report an immediate improvement in latch and a reduction in feeding-related pain. For others, improvement may be gradual as the baby learns to use their newly freed lip.
If left untreated, a mild lip tie may never cause issues. A more significant tie may continue to pose challenges for oral hygiene or contribute to a dental diastema. With proper diagnosis and management, the long-term outlook for children with lip ties is excellent.
"It was night and day after the procedure – my baby could finally latch deeply and nurse without fussing. I only wish I had known about lip ties sooner."
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.
References
About the author
Aisha Khan, MD, is a board-certified pediatrician with a focus on adolescent medicine and developmental disorders. She runs a private practice in Austin, Texas, and is a vocal advocate for child mental health services.